Medical Billing Software

Top 10 questions to ask when you are looking for a Medical Billing software vendor:

A good sales person will make a software demo presentation look great and will try to establish a rapport with you because we do buy from people like yourself.

Look beyond the demo, how much you like or dislike your sales rep and learn about the questions you need to ask.

What are my options for Medical Billing Software?

Medical billing software functionality :communications, task, electronic remittance advice (ERA) tools, word processing, patient engagement, patient portal, patient kiosk, electronic prescriptions, electronic statements, appointment confirmations, unbilled claims/visits trap, inventory control, and dashboard.

Where Can I send my electronics claims?

Electronic Claims Using Medical Billing Software: Is the software able to send electronics claims with any clearinghouse or is it locked to one option?

Can I reduce my claims rejections?

When using the correct medical billing software, do you need to have claim scrubbing before it goes out to the clearinghouse or your printer? Claim scrubbing is a tool that cleans your claims before submission to improve denial rates.

What is the accounting type am I getting?

Is the system open accounting or closed accounting? Open accounting lets you add, modify, or delete the transaction data at any time. (Open accounting has its positives and many negatives, because anyone can doctor transactions, which causes inaccuracy and financial risk). With closed accounting, once you save the transaction you can’t add, modify, or delete without an accounting trail.

What type of claims do I need?

What type of billing is the software designed for? Professional (837P) CMS 1500 02-12 format, Institutional (837I) CMS-1450 (UB 04), DME claims, pharmacy, ambulance, or labs.

Some systems may offer all of the options by using add-ons and third party software.  Others may have strengths and weakness in different areas.  Microwize can help find the right solution for your needs.

Is the database all in-one?

Database: Are the electronic medical records if needed using the same database or different database? Is the look and feel of the EMR the same of the medical billing portion or not?

Can I use the software for more than one practice?

Is the software multi tenant? This is when the same install of the software can handle different practices with different names, tax ids and financial accounts. This is helpful with billing services and independent practices sharing the same server and software.

Which pricing model are you getting in?

Pricing model: Is the pricing by provider or by seat (AKA user)? Depending on your type of business or size this can make a difference.

Do I have the reports I need?

Reports, do you have the reports you need to manage your practice? What are your options to copy a report from a marketplace or another practice you know? What is needed to customize a report? How about reports related to incentives such as meaningful use, PQRS, RVU, CCM etc…?

Is it Fat, Thin, Browser or Cloud Connections?

Technology: Is it a fat client, thin client, browser base or cloud base? A fat client is a computer (client) in client–server architecture or networks that typically provides rich functionality independent of the central server. The name is contrasted to thin client, which describes a computer heavily dependent on a server’s applications.

A fat client still requires at least periodic connection to a network or central server, but is often characterized by the ability to perform many functions without that connection. In contrast, a thin client generally does as little processing as possible and relies on accessing the server each time input data needs to be processed or validated.

Learn about Standard Industry Terminologies for Healthcare.

Just in case you need to know what any of these terms mean:

medical billing software

Medical Billing Software Functionality:

(communications, task, ERA, Electronic Remittance Advice tools, word processing, patient engagements, patient portal, patient kiosk, electronics prescriptions, electronics statement, appointments confirmations, ERA (electronics R A) unbilled claims/visits trap, Inventory control, and dashboard.

Electronic Claims Using Medical Billing Software:

Is the software able to send electronics claims with any clearinghouse or is it locked to one option?

Can I reduce my claims rejections Using Medical Billing Software?

When using the correct Medical Billing Software you need to have Claim Scrubbing before it goes out to the clearinghouse or your printer? Claim Scrubbing is a tool that cleans your claims before submission to improve denial rates.

Medical Billing Software - Clearing house Clearinghouse

Acts as an intermediary who forward claims information from healthcare providers to insurance payers. then it will perform a claims scrubbing, clearinghouses check the claim for errors, and verify that it is compatible with the payer software.
Examples of clearinghouse companies: Healthcare, Capario, Emdeon, Gateway, Greenway, Ability, etc…

Medical Billing Software - Relational Database Relational Database

A digital Database that organizes data into one or more tables (or “relations”) of rows and columns, with a unique key for each row. Generally, each entity type described in a database has its own table, the rows representing instances of that type of entity and the columns representing values attributed to that instance.

Medical Billing Software - Multi-Tenant Software Multi-Tenant Software

Multi-tenancy is an architecture in which a single instance of a software application serves multiple practices. Each practice is called a tenant. Multi-tenant software is convenient to allow the same server and software to be used for multi practices. It is something that billing companies must use when looking for medical billing software.

Medical Billing Software - SaaS Software SaaS Software

Software as a service (or SaaS) is a way of delivering applications over the Internet—as a service. Instead of installing and maintaining software, you simply access it via the Internet. Eliminates the need of a server onsite to run your software. Cloud base software also exchanged for software running without a server onsite.

Ambulatory Care Ambulatory Care

Health services rendered in a hospital outpatient facility, a clinic, or a physician’s office; often synonymous with the term outpatient care.

Allowed Amount Allowed Amount

Amount an insurance carrier will allow/approve for a billed medical procedure. Insurance carriers will sometimes limit their coverage to a portion of the approved/allowed amount (i.e. a carrier might pay only 80% of the allowed amount, with the remaining 20% due from the patient or subsequent carrier). Typically, these amounts vary on an annual basis. AKA – Reasonable and Customary

Medical Billing Software - Chargeback Chargeback

A practice management term used to describe a negative (debit, positive) payment listed on a bulk remittance from an insurance company. Larger insurance plans will “take back” a previous payment for various reasons (duplicate payment, error on first payment, patient not covered by the plan at the time of service). This type of “chargeback” affects the total amount of the paid claims (check amount) by this “chargeback” amount. AKA – Take BackRecoup or Auto-refund

Benefit Assignment Benefit Assignment

A method under which an insured person requests that his/her benefits, under an insurance claim, be paid directly to a designated physician or hospital.

Medical Billing Software - ICD ICD

The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management, and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems.
ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in World Health Organization Member States as of 1994. The implementation date for ICD-10 is October 1, 2014.
There are differences between ICD-9 and ICD-10 that are significant, including a sizeable increase in the number of new codes to address specificity. Physicians will need to move quickly to educate themselves and their staff about this major change so they can meet the October 1, 2015 compliance deadline.

Testimonials & Clients

Everybody likes to hear that he/she has done something good or right, or helped someone, and is appreciated because of this, it is good for your self esteem, even if it already is rather inflated.
I always made a point to thank the person(s) who helped me by whatever they did, especially assistents, co-workers and the like, because that will motivate them even more whenever I would need their help again, because I showed appreciation, and everybody from time to time needs help, don’t we?
Dr. Richard Filipek
Garfield, NJ

We are very fortunate to have such prompt service. Thank you for all you do to make our processing easier. A special thanks to Vaida who has been there to assist us. We are aware of her busy schedule and she has made herself available to us especially with numerous changes taking place this year.

Maria Stark, MD
Physician Scottsdale, AZ
Andrew is an excellent and well-spoken technician.He finished in the time frame he gave and resolved the issues we had with our computer. Andrew represents everything that good character and skill can afford a company to be. Microwize is doing something right if they have Andrew and techs like him.

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